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Sounds to me like a mistake made by hosiptal/nursing home. All that stay should have been at emergancy then as a admitted patiernt. Never heard of it here as when you leave emergency you have to be admitted. Otherwise you do go top ectendede acre center or rehab center. The difference is that extended care is much like a hopsi pital with medical staffing and even a ID CU plus it has rehab.Sounds to me lie its a hospital ;nursing home mistake o te ansfrrig witout medicare authrity for treatemnt to me.Especailly since it was not a emergecy to move here.Their doctor should have caught that because he has to approve the tranfer.Another reason for having a perosnal physican ;who does all tranfer and releases.Had a freind who was tranferred to ectended care and it took about a day to get medicare approval before trnafer.
Outpatient is far more profitable for the hospitals.
As usual, it's all about the money. Doesn't matter if the senior gets denied their Medicare benefits for a nursing home. Why should the hospital care? It gets paid much bigger bucks by not admitting.
Quote:
Experts estimate that outpatient services are now packed with so much hidden profit that about two-thirds of the $750 billion annual U.S. overspending identified by the McKinsey research on health care comes in payments for outpatient services.
That includes work done by physicians, laboratories and clinics (including diagnostic clinics for CT scans or blood tests) and same-day surgeries and other hospital treatments like cancer chemotherapy.
According to a McKinsey survey, outpatient emergency-room care averages an operating profit margin of 15% and nonemergency outpatient care averages 35%.
On the other hand, inpatient care has a margin of just 2%. Put simply, inpatient care at nonprofit hospitals is, in fact, almost nonprofit.
Outpatient care is wildly profitable.
“An operating room has fixed costs,” explains one hospital economist. “You get 10% or 20% more patients in there every day who you don’t have to board overnight, and that goes straight to the bottom line.”
Well - there's "in-patient" - "out-patient" and "observation status". I've been in the first two - but never the third. So what exactly is the third? Note that many surgeries where you would have been in the hospital for 3+ days 20 years ago are now - at best - overnight stays due to surgical advances. Robyn
Thanks for the post - I wish I knew what to do about it.
Too often the hard and expensive knowledge is gained after-the-fact.
Every senior needs to be made aware of this pitfall and have a very frank discussion with their doctor on their inpatient/outpatient/observation status, making very clear to the physician and hospital staff that lack of three-days' inpatient status will ultimately deny payment for nursing home and/or rehab facilities.
The doctor knows if that patient will need rehab. He should follow the correct admission protocol to assure Medicare doesn't later deny payment.
Too often the hard and expensive knowledge is gained after-the-fact.
Every senior needs to be made aware of this pitfall and have a very frank discussion with their doctor on their inpatient/outpatient/observation status, making very clear to the physician and hospital staff that lack of three-days' inpatient status will ultimately deny payment for nursing home and/or rehab facilities.
The doctor knows if that patient will need rehab. He should follow the correct admission protocol to assure Medicare doesn't later deny payment.
I might agree or disagree with you - depending on what you mean. There are post-op things younger and healthier people can deal with at home - and those that older and less healthy people can't. For example - my 94 year old father was just exploring carpel tunnel syndrome surgery. He would need to be in a nursing home after this out-patient surgery - but most younger people wouldn't. Does that mean a doctor should keep him in a hospital for 3 days for a surgery like this? Robyn
I might agree or disagree with you - depending on what you mean. There are post-op things younger and healthier people can deal with at home - and those that older and less healthy people can't. For example - my 94 year old father was just exploring carpel tunnel syndrome surgery. He would need to be in a nursing home after this out-patient surgery - but most younger people wouldn't. Does that mean a doctor should keep him in a hospital for 3 days for a surgery like this? Robyn
Of what possible relevance is a younger (we need to define younger) person's recovery time to that of a 94 y/o old man who may live, possibly, another 10 years at most? None.
Now, we may argue does a 94 y/o man need carpal tunnel surgery? However, for now, we are talking about only Medicare payment issues, not whether Medicare should pay for what appears to be elective carpal tunnel surgery and rehab on a 94 y/o man.
So, back to the subject....
Hospital admissions and insurance payment issues should always be considered, depending on the circumstances of the individual involved.
Yes, the doctor should be sure your father is an in-patient, because that doctor knows your 94 y/o father will need rehab and knows your father is on Medicare.
I know your father can afford whatever his rehab costs are, but that isn't the point. The issue is will Medicare pay for the recovery.
If Medicare is willing to pay for elective carpal tunnel surgery, then it should also be willing to pay for any subsequent rehab costs.
Also, I was not talking about younger and healthier people. I was talking about seniors. Only their doctors know their issues.
Quote:
Originally Posted by Ariadne22
Every senior needs to be made aware of this pitfall and have a very frank discussion with their doctor on their inpatient/outpatient/observation status, making very clear to the physician and hospital staff that lack of three-days' inpatient status will ultimately deny payment for nursing home and/or rehab facilities.
The doctor knows if that patient will need rehab. He should follow the correct admission protocol to assure Medicare doesn't later deny payment.
Last edited by Ariadne22; 05-10-2013 at 05:56 PM..
I guess I didn't make myself clear. Patients who have this kind of surgery don't need any rehab to speak of. It's just that older people who use walkers can't use their walkers for a period of time after - can't use grab bars - etc. They have to be in wheelchairs - need help doing things - etc. Whereas most younger people really don't need additional help if one hand is a little out of commission for a couple of weeks - an older person might. FWIW - this type of surgery takes < an hour - and is done outpatient under a local in a procedure room.
I guess we have to distinguish between the "rehab" things that a SNF does (which Medicare does cover in part) - and the custodial care things (which Medicare doesn't cover). Robyn
P.S. A few cases were mentioned in the original article - and only one specified that the patient got "rehab" at the SNF.
This has become a huge problem for many of the residents at the SNF/ALF I work at. We have had more and more residents go to the hospital with a broken bone or illness, spent time in hospital but not be officially admitted or not in time for a 3-day stay....they come back but need too much help to go back to their apartment, so they end up having to private pay $400 a day for the SNF side until they recover enough to go back.
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